Prevention of drug-induced liver injury in patients with pulmonary tuberculosis and chronic hepatitis C

Abstract

Background: Chronic hepatitis C (CHC) in pulmonary tuberculosis (TB) patients is a main risk factor for drug-induced liver injury (DILI) during anti-tuberculosis therapy (ATT), the cause of withdrawal of effective anti-tuberculosis drugs and progressive liver damage. The combination of essential phospholipids and glycyrrhizin (Phosphogliv) has approved efficacy in symptomatic treatment of CHC patients. Its role in prevention of DILI during ATT in patients with tuberculosis and CHC has not been studied. The aim is to evaluate the effectiveness of essential phospholipids/glycyrrhizin for the prevention of DILI in patients with CHC and pulmonary tuberculosis. Methods: 55 pulmonary TB patients with CHC, 45 men and 10 women aged 23-74 years (median 38 years), were included in the prospective cohort study. Active replication of the virus was noted, with baseline transaminase level of 1.5-2.5 ULN. Patients of the first group (n=27) received essential phospholipids/glycyrrhizin (Phosphogliv) 300 mg daily from the start of ATT; the control group (n=28) received ATT without Phosphoglive. The incidence of any transaminase elevation more than 3 ULN and DILI with need of anti-TB drugs withdrawal were evaluated. Results: among patients of the first group, there were fewer cases of transaminase elevation more than 3 ULN: 6/27 (22.2%) vs 14/28 (50%) in the control group, p=0.03. Clinically significant DILI requiring withdrawal of ATT was observed in 3/27 patients vs 10/28 patients in the control group (p=0.03). Conclusion: complex of essential phospholipids and glycyrrhizin is effective for preventing of liver damage and providing of uniterrupted ATT among TB patients with CHC.